Cervical cryotherapy

Definition

Cervical cryotherapy is a procedure which involves freezing an area of abnormal tissue on the cervix. This tissue gradually disappears and the cervix heals. One cervical cryotherapy is usually sufficient to destroy the abnormal tissue.

Purpose

Cervical cryotherapy is a standard method used to treat cervical dysplasia, meaning the removal of abnormal cell tissue on the cervix.

Description

Cervical cryotherapy, or freezing, usually lasts about five minutes and causes a slight amount of discomfort. The procedure is usually performed in an outpatient setting.

Cervical cryotherapy is done by placing a small freeze-probe (cryoprobe) against the cervix that cools the cervix to sub-zero temperatures. The cells destroyed by freezing are shed afterwards in a heavy watery discharge. The main advantage of cryotherapy is that it is a simple procedure that requires inexpensive equipment.

The cryogenic device consists of a gas tank containing a refrigerant and non-explosive, non-toxic gas (usually nitrous oxide). The gas is delivered using flexible tubing through a gun-type attachment to the cryoprobe.

Diagnosis/Preparation

Women who undergo cervical cryotherapy typically have had an abnormal Pap smear which has led to a diagnosis of cervical squamous dysplasia and usually confirmed by biopsy after an adequate colposcopic exam.

Preparation for cervical cryotherapy involves scheduling the procedure when the patient is not experiencing heavy menstrual flow. Ibuprofen, ketoprofen, or naproxen sodium may be given before cryotherapy to decrease cramping. If there is any doubt about the pregnancy status, a pregnancy test is performed.

Aftercare

Cervical cryotherapy is often followed by a heavy and often odorous discharge during the first month after the procedure. The discharge is due to the dead tissue cells leaving the treatment site, and Aminocerv cream may be prescribed. The patient should abstain from sexual intercourse and not use tampons for a period of three weeks after the procedure. Excessive exercise should also be avoided to lessen the occurrence of post-therapy bleeding.

Risks

The following risks have been associated with cervical cryotherapy:

• Uterine cramping. Often occurs during the cryotherapy but rapidly subsides after treatment.
• Bleeding and infection. Rare, but incidences have been reported.
• More difficult Pap smears. Future Pap smears and colposcopy may be more difficult after cryotherapy.

Normal results

A normal result is no recurrence of the abnormal cervix cells. The first follow-up Pap smear is done within three to six months. If normal, Pap smears are repeated every six months for two years. If any, recurrences usually occur within two years of treatment. Another option is to replace the initial and each yearly Pap smear with a colposcopic examination.

If a follow-up Pap smear is abnormal, a colposcopy with biopsy is usually performed. Other treatment methods, usually the loop electrocautery excision procedure (LEEP) are then used if persistent disease is discovered.

Following the procedure, it is considered normal to experience the following:

• slight cramping for two to three days
• watery discharge requiring several pad changes daily
• bloody discharge, especially 12–16 days after the procedure

Alternatives

Alternatives to cryotherapy include:

• Laser treatment. A carbon dioxide laser focuses a beam of light to vaporize the abnormal cells. This technique can be used in the physician's office with very little discomfort.
• Loop electrocautery excision procedure (LEEP). This procedure uses a fine wire loop with an electric current flowing through it to remove the desired area of the cervix. Loop excision is usually done under local anesthesia and causes very little discomfort.

See also Colposcopy ; Cone biopsy ; Cryotherapy .

Resources

BOOKS

Handley, J. What Your Doctor May Not Tell You about HPV and Abnormal Pap Smears. New York: Warner Books, 2002.

Platzer, W., et al. Vaginal Operations: Surgical Anatomy and Technique. Philadelphia: Lippincott, Williams and Wilikins, 1996.

Rushing, L., and N. Joste. Abnormal Pap Smears: What Every Woman Needs to Know. Amherst, NY: Prometheus Books, 2001.

PERIODICALS

Sparks, R. A., D. Scheid, V. Loemker, E. Stader, K. Reilly, R. Hamm, and L. McCarthy. "Association of Cervical Cryotherapy with Inadequate Follow-up Colposcopy." Journal of Family Practice 51 (June 2002): 526–529.

Tate, D. R. and R. J. Anderson. "Recrudescence of Cervical Dysplasia among Women Who are Infected with the Human Immunodeficiency Virus: A Case-control Analysis." American Journal of Obstetrics and Gynecology 186 (May 2002): 880–882.

ORGANIZATIONS

American Society for Colposcopy and Cervical Pathology. 20 West Washington St., Suite 1, Hagerstown, MD 21740. (301) 733-3640. http://www.asccp.org/index.html

National Association for Women's Health. 300 W. Adams Street, Suite 328, Chicago, IL 60606-5101. (312) 786-1468. http://www.nawh.org

OTHER

"Cervical Cancer Prevention." JHPIEG. September 2002 [cited April 2003]. http://www.jhpiego.jhu.edu/cecap .

"Cytopathology." The Internet Pathology Laboratory for Medical Education [cited April 2003].

Mayeaux Jr., E. J., M.D. "Cervical Cryotherapy Atlas." LSUH SC-S Family Medicine Server [cited April 2003]. http://lib-sh.lsumc.edu/fammed/atlases/cryo.html .

National Women's Health Information Center [cited April 2003]. http://www.4woman.org .

"What is cervical dysplasia?" AMA Medical Library [cited April 2003]. http://www.medem.com .

Monique Laberge, Ph. D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Cervical cryotherapy can be done in the treating physician's office. The physician is usually a gynecologist.

QUESTIONS TO ASK THE DOCTOR

• How is cervical cryotherapy performed?
• Why is cryotherapy required?
• What are the risks of cryotherapy?
• Is cryotherapy painful?
• What is the purpose of my cryotherapy?
• How long will it take to recover from the surgery?
• What are the after-effects of cryotherapy?
• How much cervical cryotherapy do you perform each year?